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Apr 19, 2011

The Next Big Thing: An Obesity Initiative from the NIH

The phrase "fat and happy" couldn't be going out of style faster. From the strangely coincident ads for weight loss and antidepressants on dating sites, to public weight-control initiatives out of virtually every source (including celebrity chefs and the President of the United States), being overweight has never been so unpopular—or popular, since fully a third of American adults are considered obese.

Among others, the NIH Obesity Research Task Force (established in 2003) weighed in on obesity with their 2011 Strategic Plan, a follow-up to their 2004 Plan.

The five subsections of the report describe research into biological mechanisms, social correlations, group interventions, translation into policy, and measurement tools. The results of the research so far could be summed up as: "We have identified many biological pathways contributing to obesity, connected several social and cultural features to obesity, confirmed that coaching and weight loss help prevent obesity-related disorders, and have new information-gathering techniques and ways to better estimate the seriousness of the problem. We also have a very, very long way to go—back to the lab!"

It's not for lack of effort. At least 3,800 obesity-related grants have been distributed since 2007, a purse of billions of dollars. Over 600 mention obesity in the title. And, while the connection is certainly a stretch for some of them, they really do cover every imaginable association.

From the molecular to the mundane, hard science and soft science are applied to every level of the problem.

From the influences of single proteins to the role of neighborhood planning and sidewalk connectivity, the task force jumps across disciplines to answer a few important question: Why did everyone start putting on weight? How does the body respond to being overweight? What can we do about it?"

This leads to interesting experiments. Some Amish will have their gut microflora reseeded with different strains for the advancement of science. Everything from meditation to lactation will be examined in the context of obesity.

This myriad-pronged approach demonstrates both a move to personalized medicine and a desperate need to do something about the problem, soon.

Been Here Before?

The obesity problem has several parallels: One example of a similar program in the NIH is the Office of AIDS Research (OAR), established in 1988. A look at their annual strategic plans shows a route much like that of the Obesity Task Force—the OAR weaves together basic research, therapeutics, clinical outcomes, and epidemiology.

As with HIV/AIDS, obesity drew in federal, state, and local resources to combat a rapidly spreading epidemic with both behavioral and medical interventions. This raises another similar epidemic: smoking and lung cancer.

For all three, even the initial interventions were similar: "Don't do that," where "that" refers to either unprotected sex and intravenous drugs, cigarettes, or greasy, sugary foods and a sedentary lifestyle. It took a full thirty years after the initial 1964 quit-smoking advisory to halve the per-capita tobacco consumption rate. Unfortunately, in spite of other initiatives, taxes, and interventions, there has not been much further progress.

If smoking and HIV are any indication, obesity and its associated illnesses will persist at a significantly steady-state level even after numerous public interventions. That steady state will remain until research comes up with a solution independent of behavior modification—like a cure, a vaccine, a way to clean lungs.

Perhaps, for obesity, that might be a gut symbiote that detects excessive blood sugar or some obesity marker and shuts down absorption of sugars and fats in response. If AIDS is any indication, it will be years before this research produces any major treatments, and the big cure is even further out.

Obesity is here to stay until someone comes up with a permanent, human nature-proof treatment for it. In the meantime, behavioral treatments may save an entire generation from eating itself to death. So, pass the celery!

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